Stridor 2/13/17 Dr. Yvorchuck

Question 1

3 yo TB gelding is presented w/ hx of exercise intolerance noted in the last 2 races. The horse is noted to make a respiratory noise at the time of the intolerance.

What is your dx?

Answer 1

Epiglottic entrapment (EE)

Question 2

You endoscope a 4 yo racing QH and you see this:

Answer 2

Dorsally displaced soft palate (DDSP)

Question 3

A 5 yo Warmblood mare is presented w/ hx of exercise intolerance & intermittant stridor for last 3 wks manifested only when used for jumping. An inpiratory & expiratory noise is heard.

What is the likely dx for this mare

Answer 3

EE or DDSP

not ILH d/t ILH only has inspiratory noise

Question 4

A 5 yo Warmblood mare is presented w/ hx of exercise intolerance & intermittant stridor for last 3 wks manifested only when used for jumping. An inpiratory & expiratory noise is heard.

You scope the animal and see this:

What is the definitive dx for the noise as heard in this mare?

Answer 4

EE

Question 5

You are presented with a 6 yo Holsteiner jumper mare for generation of a noise in the show ring.

You scope the animal and see this:

Answer 5

Idiopathic Laryngeal Hemplagia (ILH)

can’t say Laryngeal Hemiplagia because that doesn’t identify the side. ILH is Left Laryngeal Hemiplagia by convention!

Question 6

You are presented with a 3 yo Trotter (Standardbred) gelding who has manifested slowed racing times in his last 2 races.

What is your dx

Answer 6

RLH - right laryngeal hemiplegia (LH)

Question 7

Whats your dx

Answer 7

Axial deviation of aryepiglottic folds

Question 8

What is dx

Answer 8

subepiglottic cyst

Question 9

What does stridor w/o distress mean?

Answer 9

• When the horse is At Rest there is NO distress evident.*
• Horse does not evidence any difficulty breathing at rest.*

Question 10

Which condition is usually only an inspiratory noise?

Answer 10

ILH

Question 11

Which condition(s) can have both inspiratory & expiratory noise?

Answer 11

DDSP

EE

Question 12

What type of noise is expected in upper respiratoy tract dz

Answer 12

inspiratory only (but of course the 2 exceptions DDSP & EE)

Question 13

what are the 2 types of DDSP?

Answer 13

persistant

intermittant

Question 14

With persistant DDSP what else are you likely to see?

Answer 14

evidenced endoscopically at rest

neurogenic dysfunction - dysphagia! = CS

mechanical or inflammatory mechanisms obliterating the subepiglottic space

Question 15

what type of DDSP are most cases

Answer 15

intermittent

Question 16

Keep this image in your brain!

Answer 16

upper resp see why obligate nasal breathers

Question 17

what is pathophisiology of DDSP

Answer 17

excessive negative intrapharyngeal pressure

excessive poll flexion

epiglottic shortening

caudal retraction of larynx

Question 18

what are commonly used terms describing head carriage in horses

Answer 18

“collecting” = dressage

“holding back” = racing

“checked” = Standardbred trotters

Question 19

what mm dysfunction is important in the development of DDSP

Answer 19

thyrohyoideus mm

moves larynx rostrally & dorsally

remember only soft tissue keeps larnyx in place

Question 20

IDDSP CS

Answer 20

intermittent: temp. obstruction at high speed
* inspiratory/EXPIRATORY noise*

“Choking down”

functional obstruction

Cough especially when eating

See head & neck extension when running

Cheek puffing

Question 21

What is this?

Answer 21

DDSP

you lose contour of epiglottis unlike EE!

Question 22

Before tx DDSP what do you need to do?

Answer 22

Make sure any other concurrent respiratory issues are tx first or else you might still have DDSP after you tx it!

Question 23

DDSP Tx (non-invasive)

Answer 23

Change poll flexion

Tongue tie - Dx & Tx

Cornell Collar - Dx & Tx

Question 24

Answer 24

tongue tie

Question 25

DDSP Tx surgical

Answer 25

Laryngeal tie forward

most acceptable results currently

Question 26

Epiglottic entrapment

Answer 26

obstruction @ high speed

inspiratory/expiratory noise

• cough - especially when eating*
• can see head & neck extension when running*

May be asymptomatic

Just like DDSP

Question 27

EE pathophysiology

Answer 27

aryepiglottic & subepiglottic tissue envelope epiglottis

redundant loose tissue

some hypoplastic epiglottis

* can be concurrent w/ DDSP

this is a tissue issue whereas DDSP is a position issue!

Question 28

EE tx

Answer 28

Conservative - rest, recurrence likely!

Surgery - endoscopically guided

cutting - blade

laser - Nd: YAG laser

some w/ epiglottic augmentation